When would you go to A&E?

[Usedphone]

I suffer from chronic constipation, I've been to the GP in the past and they just have me tons of laxido and senna to use "sparingly/when needed" but that was it.

The hematologist mentioned it was related to my iron malabsorption (by not dieting it, it sediments in my colon and causes blockages). He also said there was nothing that could be done, and it had never been mentioned again.

So I've been suffering from a blockage for the last 3 weeks I still go, so I get some relief, but this time the laxatives have stopped working which made me go to the pharmacy. There the very kind pharmacist gave me like 20 mins of his time because he was shocked that after 4 senna tablets NOTHING has moved. I took them in one go btw. He then told me the next step was A&E because there was not much more tablets could do.

So then he told me to take 8 sachets of laxido and that if still nothing had moved it was hospital time.

So here I am 12 hours after I took the first 2 sachets, and about 6 since I took the last 2 (8 total) and still nothing! I just have pain but that's it.

Given that I'm not a priority case, would it make more sense to wait it out another day (and take 8 more sachets)? I'm thinking of popping in after my 9am meeting hoping that they see me before the school run, and if they don't, I just walk back home. The only thing is that for the past 5 days it has become super painful, especially my lower back.

What does 111 say?

Laxido takes time to work.

It sounds more chronic so I'm not sure what they'd do. You'd probably see someone quicker by going to the GP in the morning.

I haven't actually called them. I normally call them to avoid the GP/pharmacy but considering I've already been to the pharmacy hadn't thought of ringing them.

They have given me wild advice sometimes though. Told me once that I HAD to go to the minor injuries and not A&E (which is literally across the road from me). Minor injuries involved driving and it was an eye issue .

I used my common sense and went to a&e where the ophthalmologist told me I was completely misinformed by them.

Last time I called them for my 5yo, they told me to try and get an appointment at the GP and they couldn't do much more than that.

The pharmacist said I needed a hospital setting because the next step is an enema and or a scan to actually see the blockage and remove it "manually".

I've already been taking laxatives for the best of a week and they simply haven't worked. I haven't been to the toilet AT ALL, which is what worried the pharmacist.

You will become a medical emergency soon as you are in danger of developing an impacted bowel. Get yourself to A&E

Have you tried a dismimpaction or enema yourself?

A&E nurse here. Dr will do a digital rectal exam, probably give you an abdominal XR and an enema to try and unblock you. You wouldn’t be considered a time waster - you’ve tried everything else

Not this time. The pharmacist implied it was best if done at a hospital setting.

They were not really discussed as a "self care" option.

@Usedphone Personally, I'd increase the laxido + give it more time, and try a dismimpaction or enema. Even microlax is good.

You could ask your gp for a prescription for a mini enema

youve already sought professional help from the pharmacist, follow that advice and don’t risk your health

Problem with an enema is it will only remove what is in your rectum not what is higher up. I tell all of my patients to work up to 8 sachets, plenty of fluids and give it a few days to work. Any acute symptoms then seek further help.

So in 5 days I've had a cocktail of senna, bisacodyl, and now laxido. All to the max dosage if not more and all I get is cramps and "gargling noises" but not much else.

Laxido at 8 sachets a day is far better than the other laxatives you've been taking for impacting - keep going you've only took the 8 for one day. Any increased pain, cramps, vomiting go to A&E.

Only speaking from my own experience with severe constipation in pregnancy and my children suffering too, you have my sympathies. Laxidoo does take time to work, have you tried lactoluse? I find that works well but I take around 10ml over 4 hours (2.5ml every hour) and it does help eventually. Aside from the basics, drinking loads, plenty fruit and veg, bathing in warm water etc there’s really not much else that can be done at home. In your case I would go to A&E for some sort of suppository of some kind as a 3 week blockage must be incredibly uncomfortable. I’m shocked you’ve just been left to cope with it, I was sobbing in agony after 9 days!

I wpuld suggest the next step is picolax/ clean prep. Are you drinking plenty of water ? None of these laxatives will work with out it. Yes GP then refer to bladder and bowel team for a maintenance routine.Have you looked at this website
https://www.bbuk.org.uk/adults/adults-bowel/

Are you passing wind? If not definitely A&E as you could have an obstruction. If you are, I'd probably try GP today to see if they can give you a prescription for a mini enema. Or try some glycerin suppositories which you can get over the counter. Taking laxatives orally is loosening the top part but not the bottom.

This advice is also subject to your pain levels as if you're in terrible pain then A&E.

How many more days should I give it though? The spanner in the works is that I'm going abroad in a week's time..

My second worry is that the "blockage" has been going on for three weeks now, and standard laxatives normally resolve it within 2-3 days. Granted, it's the first time I take laxido in this way, but last time I took it (for a colonoscopy) it worked within hours.

Actually when I had my first, I became constipated and at some point couldn't even move... But it wasn't really my gut that was the problem, my uterus became severely infected after the c section, and the inflammation was causing the blockage.

I drink a LOT of water. In fact this week I've been thirstier than usual (blamed it on constipation) and I think some days I've been drinking at least 4 liters.

no more days is how many!! You’ve literally sought advice from a health care professional and now reaching out to MN for unsolicited advice
if you’re going overseas too then that’s double the reason to get it sorted
ill say it again, don’t risk your health x

You've been answered by an a n e nurse up thread. Don't risk a rupture or a heart attack.
As well as water do you drink coffee at all? That works for some

Yeah I drink around 3-4 cups every day.

Yesterday I felt so full I lost my appetite. Sometimes I find it slightly harder to breathe because of the pressure, but that was last week.

I swear by glycerine suppositories which work quickly but it sounds as if A and E is the best option

This. I've had it once and would never have been able to do it alone. Get to A&E.